Abstract

Introduction/Objective: Patients’ understanding of cardiovascular disease risk factors (CVDRF) has important implications in the adherence to treatment and trajectory of their care. We sought to understand the complex interplay between patient CVDRF knowledge, their perception of coronary artery disease (CAD) risk prior to undergoing coronary angiography, and clinical diagnosis thereafter.

Methods: Eligible study participants with at least 1 prior abnormal test were interviewed immediately prior to undergoing their first coronary angiogram for suspected CAD. Patient demographics, clinically assessed CVDRF history, patient knowledge of CVDRFs and angiographic results were captured. Patients who assessed their previous risk as low yet had prognostic CAD were identified as the ‘discordant risk group.’ Dichotomous variables were captured as frequencies and percentages, and continuous variables as means±standard deviation; differences were calculated using 2-tailed t-tests.

Results: The study population comprised of 109 (46%) women and 128 (54%) men, mean age 66.0±11.3 years, of which 137 (58%) had prognostic CAD. Among the total study population, patients that evaluated their risk for CAD as high reported more CVDRFs (CVDRF=3.28±1.5) compared to patients that reported their CAD risk as low (CVDRF=2.72±1.87) (p=0.03). However, among the 137 patients with prognostic CAD, patients who evaluated their risk for CAD as high prior to angiography were able to identify more CVDRFs compared to those who assessed their risk for prognostic CAD as low (CVDRF=3.27±1.4 vs. 2.23±1.7, p<0.01). Among the discordant risk group, the CVDRFs identified included diet, stress and family history. Despite receiving medical therapy for dyslipidemia (65%), diabetes (23%), hypertension (77%), and smoking (13%) these were not identified as CVDRFs.

Conclusions: The paradoxical relationship observed among patients who assessed their CAD risk as low yet were found to have prognostic angiographic disease is influenced by the extent of their CVDRF knowledge. This barrier to individual risk assessment may have important implications on clinical adherence and patient understanding of disease, warranting focused attention for public health messaging.